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纳米羟基磷灰石/聚酰胺66复合人工椎体在下颈椎骨折脱位前路重建中的应用

[Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation].

作者信息

Lü Chao-liang, Song Yue-ming, Liu Hao, Liu Li-min, Gong Quan, Li Tao, Zeng Jian-cheng, Kong Qing-quan, Pei Fu-xing, Tu Chong-qi, Duan Hong

机构信息

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2012 Apr;50(4):338-41.

Abstract

OBJECTIVE

To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation.

METHODS

In this study, 84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3, 12, 24 months postoperatively. The intervertebral height, physical arc (reflected by Cobb angle) and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements.

RESULTS

All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months. The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred. Postoperative immediate intervertebral height (2.4 ± 0.2) cm, preoperative intervertebral height (1.9 ± 0.1) cm, comparisons of the two groups was statistically significant (q = 2.48, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group intervertebral height was not statistically significant (P > 0.05). Preoperative Cobb angle was 9.8° ± 1.2°, postoperative immediate Cobb angle was 16.6° ± 1.2°, comparisons of the two groups was statistically significant (q = 14.25, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group Cobb angle was not statistically significant (P > 0.05).

CONCLUSIONS

n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and effectively maintain the biological alignment and cervical intervertebral height. It has high rate of graft fusion and is convenient to observe by X-ray. Therefore, n-HA/PA66 can be taken as an ideal graft for anterior lower cervical spine fracture and dislocation operation, but further follow-up study is still required to evaluate the long-term effects.

摘要

目的

初步评估n-HA/PA66人工椎体在下颈椎骨折脱位前路重建中的应用。

方法

本研究中,84例下颈椎骨折脱位患者接受了颈椎前路椎间盘切除、椎管减压或椎体次全切除、椎管减压,并采用n-HA/PA66复合人工椎体结合钢板内固定进行重建。术后3、12、24个月通过Frankel改善率随访神经功能,通过X线和三维CT观察支撑体情况。评估椎间高度、生理弧度(由Cobb角反映)以及支撑体的位置和融合率,以评估颈椎稳定性和对线改善情况。

结果

所有患者手术均成功,随访6至24个月,平均12个月。术前症状均有不同程度改善。影像学检查显示所有病例均实现植骨融合,颈椎对线、椎间高度、颈椎稳定性及人工椎体位置均维持良好。人工椎体无移位及下沉。术后即刻椎间高度为(2.4±0.2)cm,术前椎间高度为(1.9±0.1)cm,两组比较差异有统计学意义(q=2.48,P<0.001)。术后即刻、3个月、1年、2年随访组椎间高度差异无统计学意义(P>0.05)。术前Cobb角为9.8°±1.2°,术后即刻Cobb角为16.6°±1.2°,两组比较差异有统计学意义(q=14.25,P<0.001)。术后即刻、3个月、1年、2年随访组Cobb角差异无统计学意义(P>0.05)。

结论

n-HA/PA66人工椎体可早期提供颈椎支撑和稳定性,有效维持生物对线和颈椎椎间高度。其植骨融合率高,X线观察方便。因此,n-HA/PA66可作为下颈椎骨折脱位前路手术的理想植入物,但仍需进一步随访研究评估其长期效果。

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